Utilization and Outcomes of Children Treated with Direct Thrombin Inhibitors on Paracorporeal Ventricular Assist Device Support.

Thrombotic and bleeding complications have historically been major causes of morbidity and mortality in pediatric ventricular assist device (VAD) support. Standard anticoagulation with unfractionated heparin is fraught with problems related to its heterogeneous biochemical composition and unpredictable pharmacokinetics. We sought to describe the utilization and outcomes in children with paracorporeal VAD support who are treated with direct thrombin inhibitors (DTIs) antithrombosis therapy. Retrospective multicenter review of all pediatric patients (aged <19 years) treated with a DTI (bivalirudin or argatroban) on paracorporeal VAD support, examining bleeding and thrombotic adverse events. From May 2012 to 2018, 43 children (21 females) at 10 centers in North America, median age 9.5 months (0.1-215 months) weighing 8.6 kg (2.8-150 kg), were implanted with paracorporeal VADs and treated with a DTI. Diagnoses included cardiomyopathy 40% (n = 17), congenital heart disease 37% (n = 16; single ventricle n = 5), graft vasculopathy 9% (n = 4), and other 14% (n = 6). First device implanted included Berlin Heart EXCOR 49% (n = 21), paracorporeal continuous flow device 44% (n = 19), and combination of devices in 7% (n = 3). Adverse events on DTI therapy included; major bleeding in 16% (n = 7) (2.6 events per 1,000 patient days of support on DTI), and stroke 12% (n = 5) (1.7 events per 1,000 patient days of support on DTI). Overall survival to transplantation (n = 30) or explantation (n = 8) was 88%. This is the largest multicenter experience of DTI use for anticoagulation therapy in pediatric VAD support. Outcomes are encouraging with lower major bleeding and stroke event rate than that reported in literature using other anticoagulation agents in pediatric VAD support.

Differentiation of the health behavior patterns related to prostate cancer screening among African-American men in military settings.

The objectives of this study were to identify, describe, classify, and differentiate African-American men (AAM) in military settings according to the frequency with which they regularly, infrequently, or did not screen for prostate cancer using factors of the Health Belief Model. Participants in the study included 147 military health care beneficiaries who were AAM 40 years of age and older. Self-reporting questionnaires were used to collect data pertaining to the objectives. The results revealed that 85% of the men reported having screened for prostate cancer and more than 54% of them reported screening "annually." Discriminant analysis statistics revealed that age, education, and "perceived benefits" of the digital rectal examination and the prostate-specific antigen test best differentiated AAM who screened annually compared with nonscreeners. Educating AAM on the benefits and efficacy of the digital rectal examination and prostate-specific antigen tests may be helpful in increasing screening practices in this high-risk group.